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The importance of success prediction in angioaccess surgery

  • Nephrology – Review
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Abstract

Access to the circulation is an “Achilles’ heel” of chronic hemodialysis. According to the current guidelines, autologous arteriovenous fistula is the best choice available. However, the impossibility of immediate use and the high rate of non-matured fistulas place fistula far from an ideal hemodialysis vascular access. The first attempt at constructing an angioaccess should result in functional access as much as possible. After failed attempts, patients and nephrologists lose their patience and confidence, which results in high percentage of central venous catheter use. Predictive models could help, but clinical judgment still remains crucial. Early referral to the nephrologist and vascular access surgeon, careful preoperative examinations, preparation of patients and duplex sonography mapping of the vessels are very important in the preoperative stage. In the operative stage, it is crucial to understand that angioaccess procedures should not be considered as minor procedures and these operations must be performed by surgeons with demonstrable interest and experience. In the postoperative stage, appropriate surveillance of the maturation process is also important, as well as good cannulation skills of the dialysis staff. The purpose of this review article is to stress the importance of success prediction in order to avoid unsuccessful attempts in angioaccess surgery.

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Authors and Affiliations

  1. Department of Vascular Surgery, University Hospital Dubrava, Avenija Gojka Šuška 6, 10000, Zagreb, Croatia

    Branko Fila & Marko Ajduk

  2. University Clinic for Diabetes, Endocrinology and Metabolism Vuk Vrhovac, Clinical Hospital „Merkur“, Zagreb, Croatia

    Saša Magaš

  3. Department of Vascular Surgery, Clinical Hospital „Merkur“, Zagreb, Croatia

    Predrag Pavić

  4. Dialysis Department, General Hospital Bjelovar, Bjelovar, Croatia

    Renata Ivanac

  5. Department of Nephrology, University Medical Centre Ljubljana, Ljubljana, Slovenia

    Marko Malovrh

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  1. Branko Fila
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  2. Saša Magaš
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Correspondence to Branko Fila.

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Fila, B., Magaš, S., Pavić, P. et al. The importance of success prediction in angioaccess surgery. Int Urol Nephrol 48, 1469–1475 (2016). https://doi.org/10.1007/s11255-016-1318-8

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